Failed J-Pouch: Now What

In a perfect world, surgical interventions like a J-pouch would never fail, but that is not the reality. With ileoanal anastomosis surgery, or J-pouch, people with ulcerative colitis or familial polyposis are able to leave a life without an external bag. This procedure creates a J-shaped internal pouch that collects waste.  People with a J-pouch are still able to eliminate stool through the anus, as opposed to draining the pouch with a catheter.

The downside to the J-pouch is the possibility of failure. When that happens, it may be necessary to have further surgery to correct the problem.

What is J-Pouch Surgery?

Ileoananl anastomosis surgery, or J-pouch, allows people to eliminate waste in a close to normal manner after the removal of the upper or lower parts of the large intestine. Other types of ileostomy procedures create an opening in the skin to drain waste from either an internal pouch or external bag.

With J-pouch, the colon and rectum are removed. The surgeon sews the terminal ileum back onto itself to create a J-shaped pouch. The pouch is connected to the anus for drainage that is similar to moving your bowels.

J-Pouch Failure

The J-pouch procedure is a complex one that can fail. The failed J-pouch may leak, leading to potentially life-threatening pelvic sepsis. Other complications include:

• Obstruction – A blockage in the intestine that prevents stool from passing. A full obstruction is a medical emergency.
• Pouchitis – Inflammation of the pouch

Minor problems require antibiotic treatment and diet modification, but when the pouch fails completely, the doctor will convert it to another format like a BCIR.

Signs of J-Pouch Failure

Symptoms that something is wrong with your J-pouch include:

• The frequent need to pass stool – With a functioning J-pouch, you may pass stool four to seven times a day. When the pouch fails, you will go more often.
• Incontinence – A leaking pouch may allow stool to seep out

Fever, vomiting and pain are more serious signs and may indicate sepsis

What is a BCIR?

If your J-pouch does fail, the doctor can replace it with a different configuration, probably a BCIR. With a Barnett Continent Intestinal Reservoir, stool is collected in an internal pouch and removed via an opening in the skin. A BCIR, allows you to avoid an external pouch, as well, but requires you to drain waste out via a catheter instead of eliminating it through the anus.

A J-pouch allows you to live as normally as possible. If it does fail, a BCIR is preferable to a traditional ileostomy, because you can still live bag free.